MANUAL THERAPY

At a time when the NHS in the UK is under severe and mounting pressure created by a perfect storm of staff recruitment difficulties, finite resources and increasing patient demand (by numbers and expectation), it is worth thinking laterally to find solutions. NHS innovators are doing this, and talking about patient-centred approaches, integrated medicine and simple, yet-effective, messages about healthy nutrition, exercise and lifestyle choices. These are exactly the founding principles of Osteopathy!

We must remember that Osteopathy was founded as a system of medicine in the USA at a time when the ‘alternatives’ were very poor quality healthcare. In fact, during the influenza pandemic of 1918-1920, US osteopathic physicians obtained better results than their non-osteopathic medical colleagues (for a superb history of this, I’d urge you to read ‘The Great Influenza’ by John M. Barry). On the basis of this and other factors, Osteopathy grew in popularity and, in US hospitals and health centres today, DO’s work alongside MD’s performing surgery, prescribing medication as well as carrying out musculoskeletal treatments, and are fully integrated within the overall provision of community healthcare.

In the UK we have a much older, more conservative medical profession more resistant to the acceptance of ‘new’ and ‘foreign’ models of healthcare. The path to Osteopathy’s migration from the US to the UK was far from smooth and, after the fiasco of the 1935 House of Lords select committee hearing which killed the attempt to pass an Osteopaths Bill, it was not until 1993 that the osteopathic profession achieved statutory recognition. During this process, and because of our strong emphasis on palpation, Osteopathy was somewhat pigeonholed into being perceived as merely a form of manual therapy rather than a system of medicine involving diagnostic skills. I am regularly told ‘I didn’t know that osteopaths did that’ and patients (of a certain generation) reminisce about the days when their GP knew them well, had time to spend with them and actually touched them! It is very timely to be reminded that osteopaths have many of the competencies which could help to ease the pressure on A&E and GP services.

Recent developments, such as the acceptance of osteopaths in the NHS as ‘Allied Health Professionals’ and work to publicise and promote our role as the first point of contact for patients, should see the increasing use of osteopaths as a valuable human resource for community healthcare. Using public money for this will require an evidence-based approach. We always need more high-quality evidence to support the work that we do and, with a system that is patient-centred and not population-centred, there will be challenges to the type of metrics that are most suitable. Perhaps a move towards a more values-based approach will be the answer.

Current public health issues including obesity, dementia, and antibiotic resistance alert us to the fact that care strategies must evolve to remain effective. Around 30,000 patients are treated by Osteopaths every day and this week reminds us that highly-skilled, intelligent, caring and professional Osteopaths are on stand-by to be included in the team effort to achieve good public health.

With the above in mind, we would like to join our colleagues from the Institute of Osteopathy and the International Osteopathic Alliance to express our support for this year’s Osteopathy Week – 15th April – 22nd April. On behalf of our chief Osteopath, David Propert, we will be sharing valuable articles and tips on our Facebook page here and spreading the word at Dolphin Square.

Want to join us and learn more? Simply contact us here or speak to David here.

We all feel pain from time to time. When someone injures themselves, specific nerves recognise this as pain, which in turn triggers the body’s repair mechanism. As the problem resolves, the pain tends to improve and usually disappears within 3-6 months. This type of pain could be argued to be beneficial: if it hurts, you are likely to try and avoid doing whatever it is that has caused the pain in the future, so you are less likely to injure yourself in that way again.

Occasionally the pain continues even after tissue healing has finished. When pain continues after this point, it becomes known as persistent (or is sometimes referred to as chronic) pain. This type of pain is not beneficial and is a result of the nerves becoming over-sensitised, which means that a painful response will be triggered much more easily than normal. This can be unpleasant but doesn’t necessarily mean that you are doing yourself any harm simply by moving. You could think of this as a sensitive car alarm that goes off in error when someone walks past (for more information on how pain works, visit: https://www.youtube.com/watch?v=QUrKgv43W2c ).

Persistent pain is very common and affects over 14 million people in the UK alone. It often does not respond to conventional medical interventions and needs a different kind of approach, but there are many things that you can do to manage your pain yourself with the support of your osteopath, your family, and loved-ones.

Keeping active, performing exercises and stretches can help, learning to pace your activities so that you don’t trigger a flare-up of your pain as well as setting goals and priorities are all very important and can help you to maintain a fulfilling lifestyle.

Today, we would like to give you more information about the way our osteopathic treatments work and how they can be a very beneficial part of other medical procedures that you may be following.

As a primary healthcare professional our osteopaths, in addition to their osteopathic skills, have been trained to undertake detailed medical histories and a comprehensive range of clinical examinations in an effort to diagnose the cause of your symptoms.

It is due to this extensive training that they are able to determine if you may need to be referred on for further tests to determine an accurate diagnosis, or if your condition may require the intervention of another health professional.

When this happens your osteopath can write to your GP outlining their findings and requesting further investigations or referral to an appropriate consultant.

In addition to referring to your GP, our osteopaths know their local medical community well, so are well placed to recommend treatment from other health professionals who are able to treat specific conditions or even another osteopath with specialist knowledge of the condition.

Before your osteopath makes any referral, they will discuss with you their diagnosis and explain why they feel you need help from someone else.

If you are happy to be referred they will ask your permission to write to the person they are referring you to with details of your case notes and any other information from their examination that they feel might help the clinician to treat you most effectively. This may help you to get better or faster treatment because the next person to see you won’t be starting from scratch and will have the benefit of another expert’s insight into your condition. If you prefer, you can ask for a copy of your notes to take to your GP or another doctor.

If you are referred, do keep your osteopath informed about your ongoing treatment, and feel free to continue to consult him or her about any other aches and pains you’re experiencing.

Remember that we, at Calmer Clinics in Pimlico, have a great team of osteopaths who all have experience working with many medical professionals and helping their patients recover from various injuries.

Get in touch if you need any treatment or advice and we will be delighted to help you. For more information on our osteopaths, check their profiles – David and Alexia and book your appointment via our contact page or by phone.

Today we would like to give you more information about the way an osteopathic treatment is conducted at our clinic. It is important to us that you feel comfortable during your osteopathic treatment, particularly around matters of modesty and privacy.

At the start of your first session, we will ask questions about your medical history and lifestyle as well as your symptoms. This is very important as it will help us to make an accurate diagnosis and suggest appropriate treatment. This information is kept confidential in conjunction with the Data Protection Act 1998.

We will need to examine the area(s) of your body causing discomfort. Sometimes the cause of the problem may be in a different area to the pain, (for example, a difference in leg length may result in compensations in the upper back which might result in neck pain) so we may need to examine your whole body.

We will need to feel for tightness in the muscles and stiffness in the joints and may need to touch these areas to identify problems. We will explain this as we go along, but if you are uncomfortable with any part of this then let us know, we can discuss this with you or stop if you prefer.

As with a visit to a GP or other medical professional, for us to examine you effectively it may be necessary for them to ask you to remove some clothing as appropriate for the condition. This may mean undressing down to your underwear. If this is a problem for you then let us know and we will try to make arrangements that make you more comfortable.

You are also welcome to bring someone with you for all or part of your consultation, and children should always be accompanied by a parent or guardian.

Remember, if you have any questions we will be happy to discuss them with you. We look forward to hearing from you. Check our osteopaths and get in touch if you would lie to have a treatment.

Sprains and strains to muscles and joints happen to all of us and for most, they are a painful but temporary reminder to be a little more careful. Prompt action can help your body to heal faster and may prevent further injury or prolonged pain.

Strained or ‘pulled’ muscles often happen when we over-exert untrained muscles, train without properly warming up or try to go beyond a joint’s natural flexibility. Sometimes we feel the pain straight away, however, some injuries might not cause pain until later on. What can you do?

Remember RICE (Relative rest, Ice, Compression, and Elevation), using these can help to relieve the pain and start the healing process.

Relative rest: The first thing to do if you feel pain is to reduce the offending activity – pain is usually your body’s way of telling you that there is something wrong that needs your attention. It can be normal to feel a little sore after exercises for a day or two, but if it is more than this, pushing through the pain is rarely beneficial.

However, movement stimulates the healing process so stay as mobile as you comfortably can. Try to keep the joint moving through a comfortable range of motion, without forcing it to the point of pain. This will help to encourage blood flow and keep your joint flexible whilst it heals. This is particularly relevant for back pain as gentle exercise, such as walking, can help. You should slowly build your activity levels up as soon as your symptoms begin to resolve and as soon as you are able.

Ice: Cooling the area using an ice pack can help to reduce swelling and pain. Wrap a thin tea towel around the area so as to avoid direct skin contact and then apply the pack to the injured area for 10 – 15 minutes. You should repeat this several times per day for the first 72 hours. This will help to control inflammation, making it easier for your body to get blood and nutrients to the area and resolve the injured tissues.

Compression: Gently applying a compression dressing may help to temporarily support the injured joint and reduce swelling, though remove this immediately if there are signs that this is reducing the circulation to the area (numbness, pins and needles, the skin turning white or blue etc).

Elevation: If the injury is in the lower limb (knee or ankle), elevating the area a little can make it easier for your body drain fluids that might accumulate around the area, causing swelling. For example, if you’ve hurt your knee, sitting down with the knee raised on a low foot stool may ease your pain.

Seek medical attention. If you have pain that can’t be controlled with over the counter painkillers, can’t put weight on the injured limb, experience paralysis or loss of sensation or the swelling is very bad, seek help from your local A&E department, urgent care centre or telephone 111 for advice.

If the pain or swelling fails to improve within a week, a visit to an osteopath may be beneficial. They will be able to assess the injury, advise you on the correct treatment and can provide some manual therapy which may help it get better faster.

At Calmer Clinics, we have well-experienced osteopaths who have been working with athletes and sports people, the elderly, and also kids and babies.

In human anatomy, when we talk about the Vagus Nerve, we are not describing what happens somewhere in the Nevada desert. No, the 10th cranial nerve is named after the latin for ‘Wandering’. As are the words vague and vagabond. The reason this particular nerve is described as such is because it is the longest of the cranial nerves and stretches from the paired roots in the brainstem to the lowest part of the viscera, connecting with the heart along the way.The vagus nerve is part of the autonomic nervous system, responsible for functions we normally do not consciously control, although, by means of biofeedback and certain yogic and other mindfulness practices, we can learn to regulate them. The autonomic nervous system is divided into a sympathetic (‘fight/ flight’) division and a parasympathetic (‘rest/ digest’) division. The vagus nerve is part of this latter functional division and so is vitally important when it comes to controlling the vegetative, relaxation and healing/ repair processes of the body.

There is constant activity in the vagus nerve which we term ‘Vagal Tone’. So, for example, when the heart rate needs to slow down our vagal tone increases to enable this. When our gut needs to process a meal, again, vagal tone increases to facilitate digestion. Conversely, when our heart rate needs to speed up or our gut function can idle, the vagal tone decreases. This happens during the acute stress response (‘fight/ flight’) to produce the necessary physiological changes required for dealing with the situation. All perfectly healthy and normal. However, if the stressor persists (or is perceived to still be there) the stress response becomes chronic and inappropriate which is characterised by a sustained low vagal tone. This, in turn, can lead to problems such as heart beat irregularities (‘palpitations’, racing heart rate), gut disorders (IBS, acid reflux, ulcers), and inflammation.

So, one of the best ways of monitoring how stressed we are would be to measure vagal tone. But how do we do this? With the development of wearable technology and applications on devices such as the smartphone, we can now do this accurately and non-invasively. The metric used is something called ‘Heart Rate Variability’, or HRV for short, and there are several apps that can measure this. A high HRV means high vagal tone which is desirable over the long term. Individuals with low HRV (low vagal tone) over time are vulnerable to the dysfunctions associated with chronic stress (dis-stress). For example, a low vagal tone is associated with chronic inflammatory changes, including the release of chemicals called cytokines, which are fundamental to diseases such as the rheumatic conditions and atheroma as well as psychological conditions such as depression and hyper-anxiety. Recent research has shown that stimulating the vagus nerve actually secretes anti-inflammatory factors (‘Vagus nerve stimulation inhibits cytokine production and attenuates disease severity in rheumatoid arthritis’ by Koopman et al in PNAS, July 2016) and this has exciting implications for interventions in these disease processes, for example with surgically implanted vagus nerve stimulators (VNS).

Another feature of vagal tone is its role in the so-called ‘Gut-Brain’ relationship. The vagus nerve not only communicates the status of our gut to the nervous system and vice-versa but also integrates information about what is going on in the immune, endocrine, and nervous systems. We know that the ecology of the gut has profound effects on overall body physiology and the mechanisms for this are being elucidated. One of the key developments in our understanding of our relationship with gut flora has been the discovery of communicating factors produced by the commensal microbes (microbiomes) in our gut. The vagus nerve responds to these and, in turn, can transmit information to and from the gut/ brain. Those ‘gut feelings’ really are profound! A new book by Dr. Emeran Mayer, professor of medicine and psychiatry at UCLA, called ‘The Mind Gut Connection’ explores this new science of ‘Psychobiotics’.

Can we influence this without impacting a vagal stimulator or applying a Vulcan nerve pinch?

Yes, we can, and it’s not especially difficult. Vagal nerve stimulation occurs when we take a few deep breaths and breathe out slowly and forcefully to exercise the diaphragm. It also gets stimulated when we hum or speak due to the resonant frequencies (a reason, perhaps, for the efficacy of the ‘OM’ chant or singing and chanting in religious ceremonies). Splashing cold water on the face is another way of triggering a parasympathetic (vagal) response and may be linked to the so-called mammalian dive reflex. Loving-kindness meditation has been shown to induce higher vagal tone (‘How Positive Emotions Build Physical Health: Perceived Positive Social Connections Account for the Upward Spiral Between Positive Emotions and Vagal Tone’, Fredrickson and Kok 2010). Also, given the importance of the reciprocal gut/ brain connection, maintaining a healthy gut ecology is vital for good parasympathetic/ sympathetic balance.

At Calmer Clinics we are proud to have a range of clinical approaches that can address these issues, helping to restore a healthy vagal tone.